It is vitally important that we work towards ensuring the availability of safe, timely and adequate blood for all Indians, more so considering our recent challenges and foundering.
By Pradyut Bordoloi
The ongoing global pandemic has, undoubtedly, been a severe stress test for the healthcare setup in India. The cracks and shortcomings in our public health system have been brought to the fore like never, and this is a rather rude wakeup call indeed. However, as with all other aspects of policy making in India, different states have exhibited vastly different levels of competency and success in tackling the challenges posed by the virus.
An under noticed but rather important aspect of the last half a year has been the fact that our focused fight against COVID-19 has come at the cost of most making progress on most other existing ailments. For example, Child immunisation rates fell by 64%, Polio Drops fell by more than 39% and Cancer care is stated to have declined by 60%. Similarly, there has been a sharp decline in blood donations and collections across states in India owing to the lockdowns and fears of transmission of the virus; this has consequences of its own. All of this imposes real, human costs on our societies and our citizens.
In fact, even my home state of Assam has not been hit hard owing to the lack of a well-equipped, functional Blood Transfusion System (BTS) and it is something which needs immediate attention and action. For example – as per data from the NITI Aayog, 130 women die in India for every 100,000 live births due to pregnancy-related complications. At the state level however, as Kerala has the lowest maternal mortality rate (MMR) in the country at 46, Assam has an MMR of 237, which is nearly double that of all India average. Despite a 50% improvement in the last decade or so, this remains a stubbornly high figure. A rather worrying blind spot in Assam’s health systems is the continued neglect of labourers, especially women working in the state’s tea gardens mostly in parts of upper Assam. More than 800 tea gardens spread across as many as 23 districts of the state report a highly disproportionate share of these maternal deaths. It is no surprise that anaemia is near universal occurrence for workers there owing to poor levels of nutrition.
Equally important aspect to consider in this regard is how shortage of blood contributes to the state’s inordinately high MMR as well, as Postpartum Haemorrhage (PPH) i.e. excessive bleeding after childbirth accounts for nearly 30% of all maternal mortality in India. These are deaths which can be avoided if a functional blood system were to be available providing timely access to safe blood.
Similarly, be it Syphilisis, Hepatitis or HIV, countless Indians continue to get infected with Transfusion Transmitted Diseases (TTD) every year. Here, again, Assam has considerable amounts of catching up to do. One of the most important reasons behind such high incidence of TTD is that the rate of voluntary donation of blood in Assam stands at 47.9%, abysmally low as compared to the all-India average of 71.9%. It only serves to reiterate the fact that we need to make the shift towards a 100% voluntary donation of blood, doing away with replacement donations if we are to successfully deal with such issues of quality and safety during blood transfusion.
At present, India has world’s largest absolute shortage of blood, with demand outstripping supply by nearly 13 million units which translates to a staggering 400%. The unfortunate reality is that this does not have to be the case at all, given an eligible donor base of nearly 512 million people. At a state level, the annual collection of blood in Assam for the year 2018-19 stood at 2,34,488 units. This contrasts with the actual annual need of blood in the state which stood at 2,42,000 units. If we were to map the deficit in blood collections state-wise, it comes in the bottom five states. Similar is the case when it comes to the number of districts with no blood banks, a worrying reality indeed.
The pandemic has drastically worsened an already worrying scenario as far as blood systems in India go. If we can adopt efficient blood system models like the hub-and-spoke model, work towards increasing compartmentation of blood and simultaneously work towards increasing awareness about voluntary donation of blood, these are a set of challenges which can be overcome sustainably much to the benefit of our communities and India’s public health system at large. It is vitally important that we work towards ensuring the availability of safe, timely and adequate blood for all Indians, more so considering our recent challenges and foundering.
(The columnist is a Member of Parliament from Nagaon constituency, Assam. Views expressed are the columnist’s own.)